NPI | 1710525597 |
---|---|
Entity Type | Organization |
Authorized Contact | JODY M GOLDIE Owner/Manager 612-440-0345 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
Enumeration Date | 2019-12-12 |
Last Update Date | 2019-12-12 |